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A Story About Robert

Last June, Robert Nichols of Waterville was playing a round of golf, just like he had done hundreds of times before. But something was different this time. When he got to the fifth hole, his chest began to hurt, and he just wasn’t feeling well. Robert was having a heart attack.

Read more about the many other life-saving stories that take place every day at EMMC Heart Care.

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EMMC is the specialty referral hospital for the northern two-thirds of Maine, providing leading-edge programs in cancer, surgery, and cardiac care, among many others.

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On the 19th of this past month the Journal of the American Medical Association (JAMA) published a provocative study that compared the outcomes of hospitalized patients cared for by female internists

12/27/2016

On the 19th of this past month the Journal of the American Medical Association (JAMA) published a provocative study that compared the outcomes of hospitalized patients cared for by female internists with those of male internists. The result of this analysis of Medicare data has been picked up by news outlets and social media with headlines such as ‘Don’t want to die before your time? Get a female doctor’ (USA Today), and ‘So should we all get women doctors?’ (Ricochet.com).

Now before I get too far, permit me the self-disclosure that I am a male physician, and I have had more than 30 years of experience as a colleague and as an instructor to physicians of all genders. Indeed, I had personally hired four female physicians and one male physician to join me when I was in full-time office practice, if that qualifies me as less biased than some. And because we have seen how ‘fake news’ may have affected the most recent election cycle, I really think we should take a moment to look at the facts before we escalate the gender wars.

First, this large study looked at 1.5 million patients who were cared for by ‘hospitalists’ in large hospitals in the Northeast from 2011 to 2014. The doctors studied provided, on average, 51% of the care as determined by billing data, with the rest being provided by other medical specialists. Hospitalists are hardworking docs who care for inpatients only, and generally work on rotating shifts. They do not perform any surgery but occasionally may perform bedside procedures such as a central IV line. When the researchers looked at mortality stats, they found that female docs lost 11.07% of their patients versus the 11.49% of the male docs’ patients dying. Further, the data showed that readmission within 30 days was lower for the female providers, 15.02% vs 15.57%.

Half of a percentage point may not seem like a major difference, but when you have a large database, it does rise to the level of ‘significance’. Indeed, one excitable reporter calculated that if we replaced all male hospitalists with their female counterparts across the country we could save 32,000 lives! However before we all rush out to change our doctors, let’s look a little more deeply at this study. The researchers looked at the most common reasons for hospital admission for adults over 65 and were able to detect this difference in outcomes if the patient had a diagnosis of sepsis, pneumonia, and renal failure, but not for congestive heart failure, urinary tract infection, or gastrointestinal bleeding. So if you can predict your next organ failure, perhaps you could request a female doc during your next hospitalization.

Some of the speculation of why this study demonstrated a gender difference is based on previous research that showed female physicians may have a slower, more careful decision-making style, and on average were better communicators than their male colleagues -- both attributes that are valuable for treating chronic medical problems. However, the logical other side of this coin is that male providers, on average, might be better for urgent surgical problems where hand speed is necessary, or for treating problems that need the non-verbal skills such as the 3D spatial skills of an interventional radiologist.

But before we go down this hole of designing more studies to see if gender-questioning black Lithuanians are better at reading pathology slides than their white Anglo-Saxon counterparts, I think we all need to step back and acknowledge three major realities:

Female physicians have completely ‘arrived’ as quality clinicians and this study confirms what most of us know: they do an excellent job. Indeed, half of all medical students are now women.

Modern medicine is a team sport and there are a multitude of skills and talents, some of which may have slight differences across provider-types.

All of the different specialties within medicine need to be open to accepting any potential candidate regardless of their gender, race, etc., as long as they can prove their ability to do the work.

In summary, “you’ve come a long way baby” and now it’s time to get back to the hard work of delivering babies, researching disease, healing the sick, and comforting the dying for 2017 -- have a great New Year!